Pufulete Maria, Brierley Rachel C, Bucciarelli-Ducci Chiara, Greenwood John P, Dorman Stephen, Anderson Richard A, Harris Jessica, McAlindon Elisa, Rogers Chris A, Reeves Barnaby C
Clinical Trials and Evaluation Unit, University of Bristol, Bristol, UK.
NIHR Bristol Cardiovascular Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
BMJ Open. 2017 Jun 22;7(6):e014627. doi: 10.1136/bmjopen-2016-014627.
To define important changes in management arising from the use of cardiovascular magnetic resonance (CMR) in patients who activate the primary percutaneous coronary intervention (PPCI) pathway.
Formal consensus study using literature review and cardiologist expert opinion to formulate consensus statements and setting up a consensus panel to review the statements (by completing a web-based survey, attending a face-to-face meeting to discuss survey results and modify the survey to reflect group discussion and completing the modified survey to determine which statements were in consensus).
Formulation of consensus statements: four cardiologists (two CMR and two interventional) and six non-clinical researchers. Formal consensus: seven cardiologists (two CMR and three interventional, one echocardiography and one heart failure). Forty-nine additional cardiologists completed the modified survey.
Thirty-seven draft statements describing changes in management following CMR were generated; these were condensed into 12 statements and reviewed through the formal consensus process. Three of 12 statements were classified in consensus in the first survey; these related to the role of CMR in identifying the cause of out-of-hospital cardiac arrest, providing a definitive diagnosis in patients found to have unobstructed arteries on angiography and identifying patients with left ventricular thrombus. Two additional statements were in consensus in the modified survey, relating to the ability of CMR to identify patients who have a poor prognosis after PPCI and assess ischaemia and viability in patients with multivessel disease.
There was consensus that CMR leads to clinically important changes in management in five subgroups of patients who activate the PPCI pathway.
确定在启动直接经皮冠状动脉介入治疗（PPCI）途径的患者中，使用心血管磁共振（CMR）所引起的管理方面的重要变化。
采用文献综述和心脏病专家的专家意见进行正式的共识研究以制定共识声明，并设立一个共识小组来审查这些声明（通过完成基于网络的调查、参加面对面会议讨论调查结果并修改调查以反映小组讨论情况，然后完成修改后的调查以确定哪些声明达成了共识）。
共识声明的制定：四位心脏病专家（两位CMR专家和两位介入专家）以及六位非临床研究人员。正式共识：七位心脏病专家（两位CMR专家、三位介入专家、一位超声心动图专家和一位心力衰竭专家）。另外还有49位心脏病专家完成了修改后的调查。
生成了37条描述CMR后管理变化的声明草案；这些声明被浓缩为12条声明，并通过正式的共识过程进行审查。在第一次调查中，12条声明中有3条达成共识; 这些声明涉及CMR在确定院外心脏骤停原因、对血管造影显示动脉无阻塞的患者提供明确诊断以及识别左心室血栓患者方面的作用。在修改后的调查中，又有两条声明达成共识，涉及CMR识别PPCI后预后不良患者以及评估多支血管病变患者缺血和存活能力的能力。
人们达成共识，即CMR会在启动PPCI途径的五个患者亚组中导致临床上重要的管理变化。
